Clinical Epidemiology (May 2023)
Survival in Lung Cancer in the Nordic Countries Through A Half Century
Abstract
Filip Tichanek,1,2 Asta Försti,3,4 Otto Hemminki,5,6 Akseli Hemminki,5,7 Kari Hemminki1,8 1Biomedical Center, Faculty of Medicine, Charles University Pilsen, Pilsen, 30605, Czech Republic; 2Institute of Pathological Physiology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic; 3Hopp Children’s Cancer Center (KiTZ), Heidelberg, Germany; 4Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany; 5Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland; 6Department of Urology, Helsinki University Hospital, Helsinki, Finland; 7Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland; 8Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, GermanyCorrespondence: Kari Hemminki, Email [email protected]: Lung cancer is often diagnosed at an advanced stage and survival has been poor, although long-term studies have been rare. We analyzed data on survival in lung cancer from Denmark, Finland, Norway, and Sweden over a 50-year period (1971– 2020).Methods: Relative 1- and 5-year survival data were obtained from the NORDCAN database for 1971– 2020. We used generalized additive models to estimate survival trends over time and uncertainty of these estimates. We additionally calculated conditional survival from the 1st to 5th year (5/1-year), estimated annual changes in survival rates, and determined significant breaking points.Results: In 2016– 2020, 5-year survival rate for lung cancer was best for Norwegian men (26.6%) and women (33.2%). The sex difference was significant and it was found for each country. Survival improved modestly until the year 2000, after which time survival curves increased steeply and kept the linear shape to the end of follow-up, indicating consistent improvement in survival. Survival curves for 1- and 5/1-year survival were almost superimposable, indicating that deaths in the first year were approximately as many as in the subsequent 4 years, thus marking sustained long-term survival.Conclusion: We could document a positive development in lung cancer survival with steep upward trends after the year 2000. Intensions for curative treatment have been increasing and the outcomes have been improving with the help of novel imaging methods. Pathways for facile patient access to treatment have been instituted. Close to 90% of the patients are ever smokers. National anti-smoking acts and alerting people who smoke about early symptoms may be beneficial, as metastatic lung cancer remains difficult to cure.Keywords: smoking, lung cancer, relative survival, conditional survival, treatment, surgery
